			Home About us Contact

Local Anesthesia (local + anesthesia)

Distribution by Scientific Domains

Medical Sciences	96%
Life Sciences	3%

Distribution within Medical Sciences

Dermatology	37%
Anesthesia & Pain Management	9%
Cardiovascular Disease	6%
16 Other Subdomains	48%

Selected Abstracts

Safety of Lidocaine 15% and Prilocaine 5% Topical Ointment Used as Local Anesthesia for Intense Pulsed Light Treatment

DERMATOLOGIC SURGERY, Issue 7 2010
J. ALASTAIR CARRUTHERS MD
BACKGROUND Literature cautions against applying lidocaine 15%/prilocaine 5% over an area larger than 300 cm2. The area of the face, neck, and chest is 400 cm2 or greater. OBJECTIVE To investigate the safety of lidocaine 15%/prilocaine 5% topical anesthetic ointment used as anesthesia for intense pulsed light (IPL) treatment. METHODS AND MATERIALS Lidocaine 15%/prilocaine 5% ointment was applied to the face only (n=10) for 30 ± 15 minutes or to the face, neck, and chest (n=10) for a total of 60 ± 15 minutes before IPL. Blood lidocaine and prilocaine levels were measured. Adverse events were recorded. RESULTS For the entire cohort, blood was drawn 25.6 ± 6.6 minutes after IPL was completed. In the face only group, the mean lidocaine level was 0.122 ± 0.125 ,g/mL, and the mean prilocaine level was 0.048 ± 0.029 ,g/mL. In the face, neck, and chest group, the mean lidocaine level was 0.272 ± 0.208 ,g/mL, and the mean prilocaine level was 0.087 ± 0.060 ,g/mL. No adverse events related to systemic toxicity were observed or reported to the nurse. At the 24-hour follow-up, no subject reported symptoms of systemic toxicity after leaving the clinic. CONCLUSION Under the conditions of this study, topical lidocaine 15%/prilocaine 5% produces low levels of systemic absorption. The authors have indicated no significant interest with commercial supporters. [source]

Complications of Minor Skin Surgery Performed under Local Anesthesia

DERMATOLOGIC SURGERY, Issue 8 2008
AVSHALOM SHALOM MD
BACKGROUND Minor surgical procedures performed under local anesthesia are the most common surgical procedures routinely carried out in every plastic surgical practice. OBJECTIVE The objective was to evaluate the prevalence of immediate local and systemic complications of such procedures. METHODS AND MATERIALS Records of 2,600 procedures performed under local anesthesia on 2,431 patients between November 2001 and May 2004 were reviewed. Local anesthetic complications and all surgical-related complications were recorded. RESULTS Procedure-related complications were 51 presyncope (1.9%), 4 true syncope (0.16%), 2 minor burns (0.08%), and 1 facial laceration (0.04%). CONCLUSIONS True allergic reaction to lidocaine is extremely rare and none was noted in our study. Most patients who claimed that they had suffered from such a reaction were probably experiencing symptoms related to intravenous injection administration, a reaction to the added vasoconstrictor (adrenaline), or a vasovagal reaction, which is a common trait among young adults. [source]

Liposuction Using Dilute Local Anesthesia

DERMATOLOGIC SURGERY, Issue 11 2003
Timothy Corcoran Flynn MD
No abstract is available for this article. [source]

Lidocaine Iontophoresis for Local Anesthesia Before Shave Biopsy

DERMATOLOGIC SURGERY, Issue 6 2003
William T. Zempsky MD
Background. Lidocaine iontophoresis is a method of topical anesthesia in which lidocaine is driven into the skin under the influence of electric current. Objective. To compare lidocaine iontophoresis to placebo for topical anesthesia before shave biopsy in adult patients. Methods. This was a single-center, double-blind, placebo-controlled evaluation of iontophoresis of 2% lidocaine with 1:100,000 epinephrine in patients undergoing shave biopsy. Patients were evaluated for sensation to pinprick after iontophoresis. After completion of the procedure, those patients who did not receive supplemental lidocaine rated the pain associated with the procedure using a 10-cm visual analog scale. The investigator also evaluated the patient's pain after biopsy. Treatment sites were examined for evidence of adverse events such as erythema, urticaria, or burns. Results. Forty-one patients undergoing shave biopsy for evaluation of skin lesions were enrolled. Nineteen of 21 patients in the lidocaine group versus 2 of 20 placebo patients required no supplemental anesthesia (P<0.001). The pain reported by the patient on the visual analog scale subsequent to the procedure was significantly lower in the lidocaine group (P<0.001). In concordance with the results reported by the patients, investigators rated pain lower in the lidocaine group (P<0.001). Blanching and/or erythema occurring at the iontophoresis-treated site in 37 of 41 patients resolved within 1 hour. There were no other treatment-related events. Conclusions. Lidocaine iontophoresis is a safe and effective method of administering topical anesthesia before shave biopsy in adult patients. [source]

Digital versus Local Anesthesia for Finger Lacerations: A Randomized Controlled Trial

ACADEMIC EMERGENCY MEDICINE, Issue 10 2006
Stuart Chale MD
Abstract Objectives To compare the pain of needle insertion, anesthesia, and suturing in finger lacerations after local anesthesia with prior topical anesthesia with that experienced after digital anesthesia. Methods This was a randomized controlled trial in a university-based emergency department (ED), with an annual census of 75,000 patient visits. ED patients aged ,8 years with finger lacerations were enrolled. After standard wound preparation and 15-minute topical application of lidocaine-epinephrine-tetracaine (LET) in all wounds, lacerations were randomized to anesthesia with either local or digital infiltration of 1% lidocaine. Pain of needle insertion, anesthetic infiltration, and suturing were recorded on a validated 100-mm visual analog scale (VAS) from 0 (none) to 100 (worst); also recorded were percentage of wounds requiring rescue anesthesia; time until anesthesia; percentage of wounds with infection or numbness at day 7. Outcomes were compared by using Mann-Whitney U and chi-square tests. A sample of 52 patients had 80% power to detect a 15-mm difference in pain scores. Results Fifty-five patients were randomized to digital (n= 28) or local (n= 27) anesthesia. Mean age (±SD) was 38.1 (±16.8) years, 29% were female. Mean (±SD) laceration length and width were 1.7 (±0.7) cm and 2.0 (±1.0) mm, respectively. Groups were similar in baseline patient and wound characteristics. There were no between-group differences in pain of needle insertion (mean difference, 1.3 mm; 95% confidence interval [CI] =,17.0 to 14.3 mm); anesthetic infiltration (mean difference, 2.3 mm; 95% CI =,19.7 to 4.4 mm), or suturing (mean difference, 7.6 mm; 95% CI =,3.3 to 21.1 mm). Only one patient in the digital anesthesia group required rescue anesthesia. There were no wound infections or persistent numbness in either group. Conclusions Digital and local anesthesia of finger lacerations with prior application of LET to all wounds results in similar pain of needle insertion, anesthetic infiltration, and pain of suturing. [source]

A Percutaneous Approach to Eyebrow Lift: The Salvadorean Option

DERMATOLOGIC SURGERY, Issue 8 2003
Enrique Hernandez-Perez MD
Background Surgical eyebrow lift can result in a number of complications. A nonsurgical simple method of lifting the brow is presented. Objective To raise the eyebrows using a simple, quick, and noninvasive approach. Methods Twenty-nine patients, 27 women and 2 men, whose ages varied from 24 to 56 years (mean of 32 years) were included in the study. Preoperative and postoperative photographs were taken. In two patients, brow suspension was performed at the time of blepharoplasty. Informed consent was signed by all of the patients. For measuring the degree of satisfaction of the patients, we gave to them a sheet grading it from one to three (with one being the least satisfactory). Local anesthesia (1% lidocaine, 1:400,000 epinephrine), a conveniently sized Keith needle, and prolene 3/0 sutures were used. Results Satisfying results were obtained in all cases. The only problem encountered in two patients was temporary edema, and it settled in a few days. Conclusion This is a very simple, quick, and noncomplicated method of raising the eyebrows. It can be repeated, revised easily, or combined with other modalities, such as peels, topical tretinoin, oral isotretinoin, fat injection, Goretex, and Botox as part of a facial rejuvenation program. [source]

Current Concepts of Fat Graft Survival: Histology of Aspirated Adipose Tissue and Review of the Literature

DERMATOLOGIC SURGERY, Issue 12 2000
Boris Sommer MD
Background. Controversy remains about the longevity of correction in autologous fat grafts and its relation to adipocyte survival. Reported long-term fat graft survival rates differ widely, depending on harvesting method, means of reinjection, injection site, and evaluation methods. Objective. To demonstrate histologic findings of aspirated adipose tissue and compare the findings to the reports in the literature. Methods. Review of the literature and the histology of transplanted fat 7 years after subcutaneous implantation and trypan blue staining to determine the vitality of defrosted adipocytes. Results. Fat cells survive aspiration with a suction machine or syringe equally well. Use of a liposuction cannula or 14-gauge needle gives comparable results. Local anesthesia or tumescent local anesthesia is recommended for the donor site, preferably with addition of epinephrine. Conclusion. Clinical longevity of correction after autologous fat transfer is determined by the degree of augmentation resulting from the amount of fibrosis induced and the number of viable fat cells. Survival of aspirated fat cell grafts depends mainly on the anatomic site, the mobility and vascularity of the recipient tissue, or underlying causes and diseases, and less on harvesting and reinjection methods. [source]

Complications of Minor Skin Surgery Performed under Local Anesthesia

Surgical Treatment of Ingrown Toenail without Matricectomy

DERMATOLOGIC SURGERY, Issue 1 2008
BERNARD NOËL MD
BACKGROUND Partial excision of the nail matrix (matricectomy) is generally considered necessary in the surgical treatment of ingrown toenail. Recurrences may occur, however, and poor cosmetic results are frequently observed. OBJECTIVE The objective is to present a new surgical procedure for ingrown toenail with complete preservation of the nail matrix. METHODS Twenty-three patients with ingrown toenail were included in this study. The surgical excision was performed 1 week after the completion of treatment of the initial infection. A large volume of soft tissue surrounding the nail plate was removed under local anesthesia. No matrix excision was performed. RESULTS Short-term results were excellent. No recurrences or severe complications were observed during the minimum 12-months follow-up period. Cosmetic results were remarkable. CONCLUSIONS Ingrown toenail results from the compression of the lateral nail folds on the nail plate. This study shows that ingrown toenail can be surgically treated without matricectomy. A large volume of soft tissue surrounding the nail plate should be removed to decompress the nail and reduce inflammation. Cosmetic results are excellent and superior to the classical Emmert plasty. Postoperative nail dystrophies and spicule formation are not observed. The main advantage of this surgical approach is the complete preservation of the anatomy and function of the nail to improve both therapeutic and cosmetic results. [source]

Warm and Neutral Tumescent Anesthetic Solutions Are Essential Factors for a Less Painful Injection

DERMATOLOGIC SURGERY, Issue 9 2006
CHIH-HSUN YANG MD
BACKGROUND Tumescent local anesthesia is widely used in dermatologic surgery. Minimizing pain associated with injections is crucial to successful surgical procedures. OBJECTIVE This study investigates the pain associated with warm and room temperatures in neutralized or nonneutralized tumescent anesthetic solutions injection. METHODS Thirty-six patients with axilla osmidrosis who underwent local anesthesia for surgery were randomly assigned to three groups. Group A received warm neutral (40°C) and room-temperature neutral (22°C) tumescent injections to each axillary region. Group B received warm neutral (pH 7.35) and warm nonneutral (pH 4.78) tumescent injections on each side of axilla. Group C received warm nonneutral and room-temperature nonneutral tumescent injections on each side of axilla. Pain associated with infiltration of anesthesia was rated on a visual analog scale (VAS). RESULTS A statistically significant decrease (p < .001) in pain sensation was reported on the warm, neutral injection side (mean rating, 32.7 mm) compared with the room-temperature, neutral injection side (mean rating, 53.3 mm). Patient-reported pain intensity was significantly lower on the side that received warm, neutral tumescent anesthesia (mean rating, 26.8 mm) than on the side receiving warm, nonneutral tumescent anesthesia (mean rating, 44.9 mm; p < .001). The difference in VAS scores between warm neutral (mean rating, 23.9 mm) and room-temperature nonneutral (mean rating, 61.2 mm) was statistically significant (p < .001). CONCLUSION The warm, neutral tumescent anesthetic preparation effectively suppressed patient pain during dermatologic surgical procedures. [source]

Clear Cell Acanthoma Successfully Treated with a Carbon Dioxide Laser

DERMATOLOGIC SURGERY, Issue 10 2005
Ching-Chi Chi MD
Background. The treatment of choice for clear cell acanthoma (CCA) is excision. Resolution after cryotherapy has also been reported but requires three to four courses of treatment. Objective. To demonstrate three CCA lesions in two patients successfully treated with a carbon dioxide (CO2) laser. Methods. Under local anesthesia, these lesions were vaporized by using a CO2 laser in the Silktouch mode with a spot size of 5 mm and a fluence of 20 J/cm2. Two to six passes, as needed, were delivered until the tumor was completely removed. Results. Pain was minimal or nonexistent during and after the operation. No postoperative edema was noted. The wounds healed satisfactorily without scarring. No sign of recurrence was found following operation. Conclusion. The CO2 laser has the advantages of requiring only one course, precise tumor removal, a relatively bloodless surgical field, a short operation time, and less or no postoperative pain and edema. Postoperative wound care is convenient and easy with hydrocolloid and alginate dressings. The patient's quality of life is less adversely affected. The CO2 laser may be appropriate for multiple CCAs, giant CCA, CCA overlying or near joints, CCA refractory to cryotherapy, patients on anticoagulants, and those who cannot tolerate pain from cryotherapy, especially children and the elderly. [source]

Treatment of Nevoid Hyperkeratosis of the Nipple and Areola Using a Radiofrequency Surgical Unit

DERMATOLOGIC SURGERY, Issue 6 2005
Irfan Özyazgan MD
Background. Nevoid hyperkeratosis of the nipple and areola (NHNA) is a rare condition of unknown etiology. Verrucous thickening and pigmentation of the nipple and areola are the main features of the condition. Different therapeutic options, both medical and surgical, have been described. Objective. To use a radiofrequency surgical unit to treat an NHNA case, which was unresponsive to keratolytic therapy. Materials and Methods. The lesions of the nipple and areolas were excised tangentially with a diamond-shaped electrode of a radiofrequency surgical unit under local anesthesia. Results. The patient had a good cosmetic appearance after the treatment, and there was no recurrence at the ninth postoperative month. Conclusion. Radiofrequency for tangential excision in the treatment of NHNA lesions that have not responded to medical therapy can be an alternative surgical method. [source]

The Safety and Effectiveness of Single-Pass Erbium:YAG Laser in the Treatment of Mild to Moderate Photodamage

DERMATOLOGIC SURGERY, Issue 8 2004
David K. Avram MD
Background. There are several treatment modalities for mild to moderate photodamage. The demand for effective treatments with minimal side effects has increased. Objective. The objective of this study was to determine the effectiveness of short-pulsed erbium:YAG laser in treating mild to moderate photodamage. Methods. Twenty patients were treated with the short-pulse erbium:YAG laser on the face and neck. One pass was given over the entire face with two to three passes over the perioral and periorbital regions. Patients were evaluated for improvement of pigmentary irregularities, skin texture, and fine wrinkles. All side effects were recorded at follow-up visits. Two lasers were used, Sciton and Cynosure CO3, under local anesthesia. Results. There was a 58% reduction in pigment irregularities and a 54% improvement in skin texture. There was minimal improvement in fine wrinkles with one pass. Two and three passes resulted in a 50% reduction in wrinkles. The procedure was minimally painful. Side effects included 3 to 5 days of erythema and edema. Patients returned to work within 3 days on average. There were no infections. Patient satisfaction with the procedure was rated as very good. There was no difference in efficacy or adverse effects with either laser. Conclusions. One-pass short-pulse erbium:YAG laser in treating photodamage of the face and neck is safe and effective. There are minimal side effects and patients heal within 3 to 5 days. [source]

Inherited Accessory Nail of the Fifth Toe Cured by Surgical Matricectomy

DERMATOLOGIC SURGERY, Issue 8 2004
Ching-Chi Chi MD
Background. The inherited accessory nail of the fifth toe is a common condition in the Chinese population. Objective. The objective was to demonstrate three lesions in two cases of inherited accessory nail of the fifth toe successfully treated with surgical matricectomy. Methods. Under local anesthesia and use of tourniquet, the proximal nail fold was incised and the matrix of the accessory nail was exposed and then excised by scalpel surgery. The skin defect left after removal of the lesion was repaired with a rotation flap. Results. Histopathologic examination of the surgical specimens revealed that the matrices of the accessory nails were completely extirpated. No recurrence was found 2 years after operation. Conclusion. The inherited accessory nail of the fifth toe was cured by surgical matricectomy. [source]

Tumescent Liposuction Report Performance Measurement Initiative: National Survey Results

DERMATOLOGIC SURGERY, Issue 7 2004
William Hanke MD
Background. This study was created by the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement to measure clinical performance and improvement opportunities for physicians and ambulatory health-care organizations. Data were collected prospectively between February 2001 and August 2002. Thirty-nine study centers participated, and 688 patients who had tumescent liposuction were surveyed and followed for 6 months. Objective. The objective was to determine patient satisfaction with tumescent liposuction and examine current liposuction practice and the safety of tumescent liposuction in a representative cohort of patients. Methods. The Accreditation Association for Ambulatory Health Care Institute for Quality Improvement collected prospective data from February 2001 to August 2002 from 68 organizations registered for this study. Ultimately 39 organizations submitted 688 useable cases performed totally with local anesthesia, "tumescent technique." Results. The overall clinical complication rate found in the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement study was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1,5) and 84% had high levels (4 or 5 on a scale of 1,5) of overall satisfaction with the procedure. Conclusions. Our findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction. [source]

Endovenous Laser Treatment of the Lesser Saphenous Vein With a 940-nm Diode Laser: Early Results

DERMATOLOGIC SURGERY, Issue 4 2003
Thomas M. Proebstle MD
BACKGROUND Until now, endovenous laser treatment (ELT) of the lesser saphenous vein (LSV) has not been reported. OBJECTIVE To evaluate efficacy and side effects for ELT of the LSV. METHODS Otherwise unselected patients with an incompetent LSV were included. After perivenous infiltration of tumescent local anesthesia, laser energy (940 nm) was administered endovenously, either in a pulsed fashion or continuously during constant backpull of the laser fiber. Patients were scheduled for duplex follow-up at Day 1 and also at 1, 3, 6 and 12 months, postoperatively. RESULTS Forty-one LSVs were targeted in 33 patients with a median age of 66 years (range, 35 to 93). Seventy-three percent of patients had skin changes (C4). Thirty-six percent had an open or healed venous ulcer (C5,6) and 15% a postthrombotic syndrome (ES AS,D PR). Thirty-nine LSVs (95%) completed ELT successfully. During a median follow-up interval of 6 months (range, 3 to 12 months), no recanalization event could be observed. Apart from one thrombosis of the popliteal vein in a patient with polycythemia vera, only minor side effects, particularly no permanent paresthesia, could be observed. CONCLUSION ELT of the LSV under tumescent local anesthesia is feasible and effective. Caution is warranted with ELT of thrombophilic patients. [source]

Follicular Unit Transplantation: The Option of Beard Construction in Eunuchoid Men

DERMATOLOGIC SURGERY, Issue 9 2002
Kayihan, ahinoglu MD
background. Psychosocial problems are very common in eunuchoids and may be related to the impact of underlying disorders on the physical appearance which makes them unable to overcome the sense of inferiority of childhood. A beardless patient treated with follicular unit transplantation (FUT) is reported here. objective. Such patients desire to get rid of a boyish appearance and want to achieve a masculine appearance. One of the easiest methods to achieve this goal is FUT. methods. By using an 18-gauge needle, the recipient bed was prepared under local anesthesia after premedication, and 1200 one- or two-hair micrografts were transplanted to the perioral (goatee) and its extensions to the sideburns. results. After completion of the procedure to the planned area, we achieved restoration of a masculine appearance which made the patient seem quite satisfied. conclusion. The process of beard reconstruction is time consuming and tedious, but highly effective. [source]

Current Concepts of Fat Graft Survival: Histology of Aspirated Adipose Tissue and Review of the Literature

Digital versus Local Anesthesia for Finger Lacerations: A Randomized Controlled Trial

Liposomes for entrapping local anesthetics: A liposome electrokinetic chromatographic study

ELECTROPHORESIS, Issue 9 2010
Jana Lokajová
Abstract Bupivacaine is a lipophilic, long-acting, amide class local anesthetic commonly used in clinical practice to provide local anesthesia during surgical procedures. Several cases of accidental overdose with cardiac arrest and death have been reported since bupivacaine was introduced to human use. Recent case reports have suggested that Intralipid (Fresenius Kabi) is an effective therapy for cardiac toxicity from high systemic concentrations of, e.g. bupivacaine, even though the mechanism behind the interaction is not fully clear yet. Our long-term aim is to develop a sensitive, efficient, and non-harmful lipid-based formulation to specifically trap harmful substances in vivo. In this study, the in vitro interaction of local anesthetics (bupivacaine, prilocaine, and lidocaine) with Intralipid or lipid vesicles containing phosphatidylglycerol, phosphatidylcholine, cardiolipin, cholesterol, and N -palmitoyl- D - erythro -sphingosine (ceramide) was determined by liposome electrokinetic chromatography. The interactions were evaluated by calculating the retention factors and distribution constants. Atomic force microscopy measurements were carried out to confirm that the interaction mechanism was solely due to interactions between the analytes and the moving pseudostationary phase and not by interactions with a stationary lipid phase adsorbed to the fused-silica wall. The heterogeneity of the liposomes was also studied by atomic force microscopy. The liposome electrokinetic chromatography results demonstrate that there is higher interaction between the drugs and negatively charged liposome dispersion than with the commercial Intralipid dispersion. [source]

Is there a role for physiotherapy during deep brain stimulation surgery in patients with Parkinson's disease?

EUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2006
E. Chevrier
In our center, a physiotherapist is present in the operative room to bring relief to the Parkinsonian patient during subthalamic nucleus stimulation surgery under local anesthesia. This study searched to determine the causes of pain and suffering during bilateral electrode implantation and to assess the role of physiotherapy. Ninety-two consecutive patients operated on between 2001 and 2004 were included in this retrospective study. A questionnaire with eight items was developed and mailed to the patients. Seventy-five responses to questionnaires were available. All patients except one experienced physical pain and psychological suffering, alleviated by physiotherapy. These preliminary results need to be confirmed in a prospective randomized study. [source]

Tuberculosis verrucosa cutis: antitubercular therapy, a well-conceived diagnostic criterion

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 3 2005
Virendra N. Sehgal MD
A 39-year-old housewife sustained inadvertent trauma to the right index finger about 6 years ago, whilst stitching clothes. A couple of weeks later, the site of trauma became hard and gritty. Ever since, it has progressed slowly, without any appreciable outward sign. It was not associated with any discomfort/pain. Consequent on an opinion from a surgeon, it was decided to operate on the right index finger. During the operation, under local anesthesia, a hard and gritty material was removed. The material was subjected to histopathologic study. Several stitches were applied to the wound. It failed to respond to antimicrobial therapy over a 4-week period, prompting the patient to seek another opinion. Examination of the skin surface revealed a plaque with an irregular configuration on and around the distal interphalangeal joint of the right index finger. It was erythematous and pigmented. The top of the plaque was irregular and had alternating elevations and depressions (Fig. 1). Diascopy was negative for apple jelly nodule. A bacillus Calmette,Guérin (BCG) vaccination scar was identified on the left deltoid. There was no regional lymphadenopathy or systemic abnormality. Mantoux test with intradermal injection of 0.1 mL SPAN's tuberculin (purified protein derivative/5 tuberculin units/0.1 mL) (Span Diagnostic Ltd., Murat, India) was negative after 72 h. Investigations, including total and differential leukocyte count, erythrocyte sedimentation rate, serum biochemistry, and renal and liver function tests, were within the normal range, as was a chest X-ray. Figure 1. Tuberculosis verrucosa cutis before (a) and after (b) antitubercular therapy (ATT) Hematoxylin and eosin-stained sections prepared from the biopsy taken from the lesion revealed noteworthy changes in the epidermis and the dermis. The former was marked by the presence of hyperkeratosis, acanthosis, and papillomatosis, whilst the latter contained tubercle granulomas. Each of the granulomas was well formed and consisted of large numbers of lymphocytes, histiocytes, and foreign body (Langerhans') giant cells (Fig. 2). Caseation necrosis and acid-fast bacilli could not be demonstrated. The preceding revelations were fairly conducive to the diagnosis. Accordingly, antitubercular therapy (ATT), comprising 450 mg of rifampicin, 300 mg of isonicotinic acid hydrazide, and 800 mg of ethambutol, was recommended for oral administration each day for 60 days. The outcome of the treatment was satisfactory, resulting in perceptible regression of the skin lesion (Fig. 1b). The patient was advised to continue the treatment for another 30 days, after which 450 mg of rifampicin and 300 mg of isonicotinic acid hydrazide were to be continued for another 6 months. Figure 2. Tuberculosis verrucosa cutis depicting well-formed tubercle(s) comprising lymphocytes, histiocytes, neutrophils, and a few giant cells (hematoxylin and eosin, × 100) [source]

Impact of chronic advanced aortic regurgitation on the perioperative outcome of noncardiac surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010
H.-C. LAI
Background: Whether and how chronic advanced aortic regurgitation (AR) impacts the perioperative outcome of noncardiac surgery remains unclear. Methods: From November 1999 to December 2006, all patients undergoing noncardiac operations and ever examined by echocardiography within the last 6 months were screened. Those with chronic moderate,severe or severe AR were enrolled, provided they were not already trachea-intubated or aortic valve operated, and the surgery was not performed under local anesthesia. Case-matched subjects without significant AR served as controls. The perioperative outcomes of these patients were analyzed, and independent prognostic correlates were investigated by multivariate logistic regression analysis. Results: A total of 167 patients (male 131, mean age of 75 years) complying with the enrollment criteria were studied. Compared with the other 167 case-matched control peers, patients with advanced AR risked potential hazards of serious hemodynamic instability (0.6%) and circulatory collapse (1.2%) during surgery despite the similar incidence of overall cardiac adverse events, and were further distressed with more cardiopulmonary complications (16.2% vs. 5.4%, P=0.003) and in-hospital deaths (9% vs. 1.8%, P=0.008) post-operatively. Multivariate regression analysis confirmed the correlation of advanced AR with perioperative mortality, and identified depressed left ventricular function, renal dysfunction, high surgical risk, and lack of cardiac medication as predictors of in-hospital death. Conclusion: Chronic advanced AR complicates the perioperative outcome of noncardiac surgery as reflected by frequent cardiopulmonary morbidities and in-hospital deaths, especially when coexisting with specified high-risk clinical and surgical characteristics. [source]

Radio-frequency ablation of renal cell carcinoma in patients who were at significant risk

INTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2004
OSAMU UKIMURA
Abstract, Objective:, Although radio-frequency ablation (RFA) has been recently applied as a minimally invasive treatment option for renal cell carcinoma (RCC), indication of this modality remains a critical issue due to the lack of complete tumor destruction as well as the uncertainty of its long-term efficacy. We report the efficacy of RFA for nine carefully selected patients with RCC who had significant reason to avoid invasive surgical treatment under general anesthesia. Methods:, Radio-frequency ablation was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in nine patients with biopsy proven RCC (mean diameter, 38 mm; range, 20,53 mm), who were at significant operative or anesthetic risk for invasive surgery. Follow-up enhanced CT scans or magnetic resonance images were evaluated every 3,6 months and an evaluation of metastasis was performed every 6 months. Results:, At a mean follow-up of 17 months, seven (78%) of the nine patients with renal tumor showed no tumor enhancement. The renal function of all patients was well preserved. All patients were able to continue undergoing their respective treatments for active diseases in other organs in parallel to the RFA treatment. No distant metastasis, urine leakage were reported and one case of temporary hematuria and one case of peri-renal hemorrhage not requiring blood transfusion were encountered. Intra-operative ultrasonography was useful in the real-time monitoring of the minimally excessive extension of ablation into the normal parenchyma. Conclusion:, Radio-frequency ablation appears to be an effective and safe minimally invasive therapeutic option for selected patients with RCC who have reason to avoid invasive surgery under general anesthesia. [source]

Randomized trial of trigger point injection for renal colic

INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2002
MASANORI IGUCHI
Abstract Background: Many drugs have been utilized for the treatment of renal colic, but to date no drugs that relieve pain quickly and completely have been developed. Thus, we conducted a prospective trial to evaluate the effects of trigger point injection on renal colic. In this study, we used a local injection of lidocaine to the trigger point of patients experiencing renal colic, and evaluated the efficacy in patients using the visual analog scale. Methods: Sixty patients with renal colic were enrolled in this study and divided into two groups by a simple randomization: (i) the butylscopolamine group (n = 30, intravenous injection of butylscopolamine bromide and sulpyrine); and (ii) the lidocaine group (n = 30, local anesthesia to the trigger point with lidocaine). Results: Renal colic had disappeared completely at the end of the trigger point injection in 15/30 patients and the average time required to produce a 50% improvement in symptoms was 9 min in all patients in the group. In the lidocaine group, only one patient needed an additional anodyne treatment after 60 min and none of the 29 patients whose pain disappeared within 60 min needed further anodyne treatment within 24 h. These results were all significantly superior to those of the conventional treatment. No side-effects and complications were observed. Conclusion: Trigger point injection, in our experience, is an easy, safe and effective method for the amelioration of renal colic. It was significantly superior to the combination of intravenous butylscopolamine and sulpyrine. [source]

Flexible video cystoscope with built-in high-frequency cauterizing element for transurethral resection of bladder tumor

INTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2001
MASAKO KAWAKAMI
Abstract The major advantage of the flexible video cystoscope is that a digital signal can be obtained while high frequency cauterization is carried out. Cauterization while observing a digital signal picture was not possible before this new model was developed. We decided to use this new cystoscope to resect a bladder tumor and coagulate the bleeding because the patient could tolerate only local anesthesia due to severe heart disease complications. We successfully treated the patient with this technique and no complications were noted. This new flexible video cystoscope was found to be safe for resecting bladder tumor under local anesthesia. [source]

Ineffectiveness of Local Wound Anesthesia to Reduce Postoperative Pain After Median Sternotomy

JOURNAL OF CARDIAC SURGERY, Issue 4 2005
Diego Magnano M.D.
Bupivacaine wound infiltration is frequently used to reduce the pain related to the surgical incision itself. In this randomized study, we investigated the efficacy of bupivacaine local anesthesia after median sternotomy to reduce postoperative pain. Forty-seven patients undergoing major cardiac surgery procedures were allocated randomly to group A (bupivacaine wound infiltration 0.5%; 10 mL, followed by continuous infusion: 10 mg/24 H) or to group C (controls). Extubation time, postoperative arterial blood gases, postoperative pain (assessed by means of a visual analog scale), and morphine consumption were the endpoints of the study. Patients of group C were extubated earlier; blood gases and VAS values were similar in both group. Bupivacaine local analgesia did not improve postoperative pain control after median sternotomy. [source]

A pathologist's perspective on bone marrow aspiration and biopsy: I. performing a bone marrow examination

JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 2 2004
Roger S. Riley
Abstract The bone marrow aspirate and biopsy is an important medical procedure for the diagnosis of hematologic malignancies and other diseases, and for the follow-up evaluation of patients undergoing chemotherapy, bone marrow transplantation, and other forms of medical therapy. During the procedure, liquid bone marrow is aspirated from the posterior iliac crest or sternum with a special needle, smeared on glass microscope slides by one of several techniques, and stained by the Wright-Giemsa or other techniques for micro-scopic examination. The bone marrow core biopsy is obtained from the posterior iliac crest with a Jamshidi or similar needle and processed in the same manner as other surgical specimens. Flow cytometric examination, cytochemical stains, cytogenetic and molecular analysis, and other diagnostic procedures can be performed on bone marrow aspirate material, while sections prepared from the bone marrow biopsy can be stained by the immunoperoxidase or other techniques. The bone marrow procedure can be performed with a minimum of discomfort to the patient if adequate local anesthesia is utilized. Pain, bleeding, and infection are rare complications of the bone marrow procedure performed at the posterior iliac crest, while death from cardiac tamponade has rarely occurred from the sternal bone marrow aspiration. The recent development of bone marrow biopsy needles with specially sharpened cutting edges and core-securing devices has reduced the discomfort of the procedure and improved the quality of the specimens obtained. J. Clin. Lab. Anal. 18:70-90, 2004. © 2004 Wiley-Liss, Inc. [source]

The anesthetic onset and duration of a new lidocaine/prilocaine gel intra-pocket anesthetic (Oraqix®) for periodontal scaling/root planing

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2001
Johan Friskopp
Abstract Background: A new non-injection anesthetic, lidocaine/prilocaine gel (Oraqix®, AstraZeneca) in a reversible thermosetting system, has been developed to provide local anesthesia for scaling/root planing (SRP). The aim of this study was to determine the anesthetic onset and duration of the gel for SRP in patients with periodontitis. Methods: 30 patients were randomized to either 30 s, 2 min, or 5 min of treatment with the gel prior to SRP of a tooth. The gel was applied to periodontal pockets with a blunt applicator. On completion of the SRP of each tooth (2,3 teeth treated/patient), the patients rated their pain on a 100-mm visual analogue scale (VAS). Results: The median VAS pain score was 7.5 mm in the 30-s group, 28.5 mm in the 2-min group, and 15.5 mm in the 5-min group, with a significant difference between the 30-s and 2-min groups (p=0.03). In 2 patients in the 5-min group, but none in the other groups, the SRP was interrupted due to pain. The mean duration of anesthesia measured as pain on probing were 18.1, 17.3, and 19.9 min in the 30-s, 2-min, and 5-min groups, respectively. There were no reports of numbness of the tongue, lip, or cheek, neither were there any adverse local reactions in the oral mucosa. The gel was easy to apply and did not interfere with the SRP procedure. Conclusion: Oraqix® provides anesthesia after an application time of 30 s, with a mean duration of action of about 17 to 20 min. Zusammenfassung Hintergrund: Eine neues nicht zu injizierendes Anästhetikum, Lidocain/Prilocain Gel (Oraqix®, Astra Zeneca) in einem reversiblen thermischen System, wurde entwickelt, um die lokale Anästhesie für die Wurzelreinigung und -glättung (SRP) zu verbessern. Das Ziel dieser Studie war die Bestimmung des Anästhesieeintrittes und der -dauer durch dieses Gel bei SRP bei Parodontitis-Patienten. Methoden: 30 Patienten wurden zufällig zur 30 Sekunden, 2 Minuten oder 5 Minuten Behandlung mit dem Gel vor der SRP eines Zahnes eingeteilt. Das Gel wurde mit einem stumpfen Applikator in die parodontalen Taschen appliziert. Nach der Vollendung der SRP eines jeden Zahnes (2,3 behandelte Zähne/Patient) beurteilten die Patienten ihre Schmerzen auf einer 100 mm visuellen Analogskala (VAS). Ergebnisse: Der mittlere VAS Score war 7.5 mm in der 30 Sekundengruppen, 28.5 mm in der 2 Minutengruppe und 15.5 mm in der 5 Minutengruppe mit einer signifikanten Differenz zwischen der 30 Sekunden und der 2 Minutengruppe (p=0.03). Bei 2 Patienten in der 5 Minutengruppe, aber keinem in einer anderen Gruppe, wurde das SRP wegen Schmerzen unterbrochen. Die mittlere Dauer der Anästhesie, gemessen als Schmerz auf Sondierung, war 18.1, 17.3 und 19.9 Minuten in der 30 Sekunden, 2 Minuten und 5 Minutengruppe. Es gab keine Berichte über eine Taubheit der Zunge, der Lippen oder der Wangen. Irgendwelche negativen lokalen Reaktionen an der Mukosa wurden nicht beobachtet. Das Gel war leicht zu applizieren und beeinflußte die SRP Prozedur nicht. Zusammenfassung: Oraqix® fördert die Anästhesie nach Applikation von 30 Sekunden mit einer mittleren Dauer von ungefähr 17 bis 20 Minuten. Résumé Un nouvel anesthésique non-injectable, un gel de lidocaine/prilocaine (Oraquix®, AstraZeneca) dans un système thermique réversible a été mis au point afin de créer une anesthésie locale lors du détartrage et du surfaçage radiculaire (SRP). Le but de cette étude a été de déterminer la prise et la durée anesthésique de ce gel pour le SRP chez des patients avec parodontite. 30 patients ont été traités avec ce gel pendant 30 s, 2 min ou 5 min avant le SRP d'une dent. Le gel a été placé dans les poches parodontales avec un applicateur arrondi. A la fin du SRP de chaque dent (2 à 3 dents traitées par patient) les patients ont quantifié leur douleur sur une échelle analogue visuelle de 100 mm (VAS). Le score de douleur VAS moyen était de 7.5 mm dans le groupe de 30 s, 28.5 mm dans le groupe 2 min et de 15.5 min dans celui de 5 min avec une différence significative entre les groupes 30 s et 2 min (p=0.03). Chez 2 patients du groupe 5 min mais chez aucun des 2 autres groupes le SRP a été interrompu à cause de la douleur. La durée moyenne d'anesthésie mesurée en tant que douleur au sondage était respectivement de 18.1, 17.3 et 19.9 min pour les groupes 30 s, 2 min et 5 min. Il n'y a eu aucune plainte d'anesthésie de la langue, des lèvres ou des joues ni aucune réaction locale négative de la muqueuse buccale. Le gel a été facilement appliqué et n'a absolument pas gêné le SRP. L'Oraquix® apporte une anesthésie après un temps d'application de 30 s avec une durée d'action de 17 à 20 min. [source]

Complications and limitations related to periprostatic local anesthesia before TRUS-guided prostate biopsy

JOURNAL OF CLINICAL ULTRASOUND, Issue 2 2008
Ahmet T. Turgut MD
Abstract Purpose To assess the frequency of complications specifically related to local anesthetic infiltration prior to transrectal ultrasound (TRUS)-guided prostate biopsy. Methods A total of 200 patients receiving 10 cm3 (5 cm3 on each side) of 2% lidocaine injected around the periprostatic nerve plexus under TRUS guidance before prostate biopsy were included. Various complications presumed to be associated with local anesthesia were noted during and after the biopsy procedure. Two weeks later, periprostatic tissue integrity and vascularization were re-examined with TRUS Doppler examination to assess for fibrosis or infection. Results The most common finding was pain due to puncture with the needle used for local anesthesia (27%). Also recorded were the need for repeated injections during the biopsy procedure (4.5%), symptoms associated with systemic lidocaine toxicity (2%), urinary incontinence (1.5%), and degradation of the image resolution due to anesthetic injection (1%). Increased vascularization within the periprostatic region was uncommon (2%) on the 2-week follow-up examination. No TRUS finding consistent with rectal wall hematoma or other periprostatic change and no erectile dysfunction associated with the procedure occurred. There was a significant difference in overall pain scores between the subgroups of patients (p < 0.001). Conclusion TRUS-guided periprostatic nerve blockade is an effective method for relieving discomfort from prostate biopsy with very few complications. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source]